"There's only one way of dealing with stress - that's to
identify the cause and then work to reduce or eliminate that cause. I believe bullying is
the main, but least recognised, cause of stress in the workplace today."
Tim Field

"Poor management is a major cause of stress."
Dr Peter Graham, Head of Health Directorate, UK Health & Safety Executive, 24 September 1998

Stress is not the employee's inability to cope with excessive
workloads and the unreasonable demands of incompetent and bullying managers; stress is a
consequence of the employer's failure to provide a safe system of work as required by the
UK Health & Safety at Work Act 1974. Blaming the sufferer of stress for suffering
stress is an admission of failure to fulfil this obligation of duty of care.

The HSE publication Working
on Stress describes the view that "All you need to do is go for
counselling to stop work-related stress" as "wrong"
and as being "unlikely to tackle the source of the problem".

Positive stress (or eustress) is the result of competent management and mature
leadership where everyone works together and everyone is valued and supported. Positive
stress enhances well-being and can be harnessed to enhance performance and fuel
achievement.Negative stress (or distress) is the result of a bullying climate where threat,
coercion and fear substitute for non-existent management skills. Employees have to work
twice as hard to achieve half as much to compensate for the dysfunctional and inefficient
management. Negative stress diminishes quality of life and causes injury to health
resulting in the symptoms of ill-health described on this page. When people use the word
"stress" on its own, they usually mean "negative stress". The CBI
estimates stress and stress-related illness cost UK industry and taxpayers £12 BILLION
each year. The UK Department of Health state that 3.6% of national average salary budget
is paid to employees off sick with stress. Stress is now officially the Number One cause
of sickness absence although 20% of employers still do not regard stress as a health and safety issue.

psychological symptoms - panic attacks, reactive
depression (which some people describe as Adjustment Disorder with
depressed mood), thoughts of
suicide, stress breakdown (this is a psychiatric injury, not
a mental illness), forgetfulness, impoverished or intermittently functioning memory, poor
concentration, flashbacks and replays, excessive guilt, disbelief and confusion and
bewilderment ("why me?" - click here for the answer), an
unusual degree of fear, sense of isolation, insecurity, desperation, etc; one experiences
acute anxiety at the prospect of meeting the bully or visiting the location where the
bullying took place, or at the thought of touching the paperwork associated with the case;
one is unable to attend disciplinary meetings and may vomit before, during or after the
meeting, sometimes at the thought of the meeting or on receiving a threatening letter
insisting one attends (these are PTSD
diagnostic criteria B4 and B5)

Increasingly researchers are suggesting that diabetes, asthma, allergies, fibromyalgia,
multiple sclerosis (MS), chronic fatigue syndrome (ME) and even some forms of cancer are
caused or aggravated by stress. An article in Biologist (T cells divide and rule in Gulf War syndrome (and asthma, TB, cancer, ME),
Jenny Bryan, Immunology section in The Biologist, (1997) 44 (5)) suggests that a
shared immunological defect may link many disorders. Others suggest that the
inappropriateness of the stress response in dealing with modern threats - which are
largely psychological rather than physical - is to blame.

The traumatising effect of bullying results in the target being unable to state clearly
what is happening to them and who is responsible; the target may be so traumatised that
they are unable to articulate their experience for a year or more after the event. This
often frustrates or prevents legal action: see
12-week tribunal application limit and
psychological reactivity of PTSD.

Another frustration is incorrect diagnosis by a medical or mental health
professional who doesn't understand Complex PTSD or who is antagonistic towards
the concept of psychiatric injury. If you're under one of these characters,
ditch them immediately as they will sabotage both your legal case and your
efforts to recover. False diagnoses commonly given include schizophrenia,
paranoia, work phobia, school phobia, borderline personality disorder (as a cause
rather than a symptom), etc.

Bullying results in strong feelings of fear, shame, embarrassment, and guilt, which are
encouraged by the bully to keep their target quiet. This is how all abusers (including
child sex abusers) silence their targets. For detailed reasons why targets of abuse don't
or can't report their abuse, click here.

Work colleagues often withdraw their support and then join in with the bullying, which
increases the stress and consequent psychiatric injury; to see why mobbing breaks out,
click here.

Poor concentration, impaired memory, and fatigue are common and early signs of
excessive stress. These have significant Health & Safety implications if the employee
drives a vehicle, operates machinery, or is responsible for the care or welfare of others
as part of their duties. RoSPA estimate that in the UK at least 1000 road deaths each year
involve people for whom driving is part of their job. Fatigue is a major factor.

The fight or flight mechanism, or stress response, is designed for responding to physical
danger (eg being about to be attacked by a sabre-toothed tiger) but today is more likely
to be activated by a psychological danger (eg bullying at work, harassment,
stalking, abuse) for which it was not designed. The stress response can also be activated
by anticipation of low-probability or long-term or non-life-threatening events such as
financial problems (clinching the next big deal, how to pay the mortgage next month,
wondering when the next benefit cheque will arrive), motorway traffic jams, job security,
picking up a parking ticket for a car park overstay, etc.

Different people respond with different degrees of stress to different stressors, a
fact which has dogged research. However, there are at least four factors which determine
the degree to which one will feel stressed:

control: a person feels stressed to the extent to which they perceive they are
not in control of the stressor; at work, employees have no control over their management

predictability: a person feels stressed to the extent to which they are unable
to predict the behaviour or occurrence of the stressor (bullies are notoriously
unpredictable in their behaviour)

expectation: a person feels stressed to the extent to which they perceive their
circumstances are not improving and will not improve (a bullying situation almost always
gets worse, especially as one gains insight into the cause)

support: a person feels stressed to the extent to which they lack support
systems, including work
colleagues, management, personnel,
union, partner, family, friends, colleagues, persons in authority, official bodies,
professionals, and the law

Once the stress response is activated, the body's energy is diverted to where it is
needed, thus heart rate, blood pressure and breathing rate increase. All non-essential
body functions are temporarily shut down or operate at reduced level; these include
digestion, growth, sexual systems (menstrual cycle, libido, testosterone production),
immune system, storage of energy as fat, etc. In response to threat, glucose, proteins and
fats are rapidly released from storage (in muscles, fat cells and liver) and energy
becomes abundantly available to those muscles which will help you fight the danger or run
away from it. In extreme cases bowels and bladder will spontaneously evacuate to lighten
the load; the smell may also help to deter the attacker. There is no point in digestion,
reproduction and immune system etc continuing to operate if you're likely to be the
sabre-toothed tiger's dinner in the next ten minutes - better divert that energy into
avoiding being on the menu.

Therefore, the prospect of going to work, or the thought or sound of the bully
approaching immediately activates the stress response, but fighting or flight are both
inappropriate. In repeated bullying, the stress response prepares the body to respond
physically when what is required is an employer-wide anti-bullying
policy, knowledge of bullying motivations and tactics, assertive responses to defend
ourselves against unwarranted verbal and physical harassment, and effective laws against
bullying as an ultimate deterrent or arbiter when all else fails.

The fatigue caused by bullying is understandable when you realise that the body's fight
or flight mechanism ultimately becomes activated for long periods, sometimes
semi-permanently. For a person with a regular daytime job, the activation can last from
Sunday evening - at the prospect of having to go to work the following day - through to
the following Saturday morning - at the prospect of two days relief.

The fight or flight mechanism is designed to operate briefly and intermittently, but
when activated for abnormally long periods, causes the body's physical, mental and
emotional batteries to drain dry. Energy stored in the body as protein, glycogen and
triglycerides is rapidly converted back to amino acids, glucose and fatty acids etc to
help the body deal with the perceived threat. The process of conversion, achieved via the
release of stress hormones such as glucocorticoids, glucagon, epinephrine (adrenaline) and
norepinephrine (noradrenaline), itself consumes energy. The stress hormones also trigger
the conversion of protein in those muscles not required for flight or fright into amino
acids.

Whilst the human body is capable of withstanding considerable levels and periods of
stress, when the stress response is turned on for long periods, the body inevitably
sustains damage through prolonged raised levels of glucocorticoids (which are toxic to
brain cells), excessive depletion of energy reserves, resulting in fatigue, loss of
strength and stamina, muscle wastage (as in steroid myopathy when patients receive large
doses of glucocorticoids to treat various illnesses), and adult-onset diabetes.

At the weekend and days off, the weakened immune system cannot fight off viruses (eg
colds, flu, glandular fever etc) and the person suffers constant illnesses during which
the batteries do not recharge. Even without viral infection, the obsessiveness and
disturbed sleeping patterns prevent the body from replenishing stored energy. Reactivation
of the fight or flight mechanism prior to returning to work produces a flow of stress
hormones which appear to temporarily suppress the effects of illness.

Many people who are bullied experience and report symptoms similar to Chronic Fatigue
Syndrome (formerly ME, myalgic encephalomyelitis, also called Chronic Fatigue Immune
Deficiency Syndrome [CFIDS] and Post Viral Fatigue Syndrome). The main symptoms are:

overwhelming fatigue

pains in the joints and muscles with no obvious cause

occasional bursts of energy, followed by exhaustion and joint/muscle pain

inability to concentrate

poor recall, eg words, sentence construction, etc

mood swings, including anger and depression

difficulty in learning new information

sense imbalances, eg in smell, taste and appetite

dislike of loud noises and bright lights

inability to control body temperature

sleep disturbance (eg sleeping by day and waking at night)

disturbance of balance

clumsiness, eg unable to grasp small objects, inability to separate sheets of paper

Chronic Fatigue Syndrome achieved official recognition from the
UK's Chief Medical Officer Sir Kenneth Calman on 15 July 1998. This view was
endorsed by a report
published in January 2002 which was compiled for Chief Medical Officer for England.
Professor Sir Liam Donaldson called for the recognition of Chronic Fatigue
Syndrome (CFS or CFIDS, also known as myalgic encephalomyelitis or ME) as a
chronic condition with long term effects on health on a par with illnesses
such as multiple sclerosis and motor neurone disease. The report also recommends
early diagnosis, better access to treatment, and that CFS/ME should be
included in the education and training of doctors, nurses and
other healthcare professionals. The only omission from the
report seems to be that one of the causes of CFS can be long-term bullying,
harassment and abuse, which compromise the body's immune system and drain the body's energy reserves.

The syndrome is not well
understood, but a virus in the same family of enteroviruses as multiple sclerosis (MS) and
polio is thought to be implicated. The only cure is complete rest. Exercise, which in
people without CFS strengthens the body and aids good health, makes the condition worse.
CFS is often linked to stress and trauma, although the stressors may not always be obvious.

Irritable Bowel Syndrome, or IBS, is a classic symptom of stress. It's not a
disease but a functional disorder (ie a malfunction) of the digestive system,
hence it's other name of spastic colon.
Certain foods, especially wholewheat and fat, cause a violent spasm of the
intestine resulting in abdominal pain (often excruciating), stomach cramps,
bloating, endless tummy rumbling, gas,
belching,
nausea and sometimes vomiting, constipation or diarrhoea (or both alternating)
and a general debilitating feeling of great unwellness. Attacks are triggered by
certain foods and can last a day. The cause is unknown and IBS can start at any
age with no apparent reason, although long-term stress is often, if
unscientifically, implicated. Up to 20% of the population may experience IBS to
some degree, but sufferers may find diagnosis can be difficult to obtain. There's no "cure" but strict attention to diet can reduce or even
eliminate the symptoms. Many people suffer for years before obtaining diagnosis,
after which their life is transformed with a new diet. More at Help For
IBS.com.

Over time, the symptoms described above result in psychiatric injury, which is not
a mental illness. Despite superficial similarity, and comments (both direct and implied)
from those around you, there are many distinct differences between psychiatric injury and
mental illness including

a) mental illness is assumed to be inherent (internal) whereas psychiatric injury is
caused by something or someone else (external) - who is liable;
b) an injury is likely to get better;
c) the person suffering mental illness exhibits a range of symptoms associated with mental
illness (paranoia, schizophrenia, delusions, etc) but not with psychiatric injury, whereas
the person suffering psychiatric injury will typically exhibit a range of symptoms (eg
hypervigilance, hypersensitivity, obsessiveness, irritability, fatigue, sleeplessness)
associated with psychiatric injury but not with mental illness.

A table showing the differences between psychiatric injury and mental illness is on the
PTSD page - click here.

Reactive depression
One of the symptoms of psychiatric injury is reactive depression - it is a reaction to an external
event. My understanding is that the chemistry of reactive depression is different to clinical or endogenous
depression (which is associated with mental illness).

If you are diagnosed as suffering depression as a result of bullying at work, make sure
it is diagnosed (eg on your sick note) as reactive depression. The word
"depression" on its own is usually (mis)interpreted (especially by the bully) as
"endogenous depression".

In April 2005 researchers from King's College Hospital identified depression as the main reason of sickness
absence, although they made no mention of a primary cause of depression, ie cumulative negative stress
caused by bullying. [More]

In every workplace bullying relationship the symptoms suffered by the target eventually
become sufficiently noticeable that people start to ask questions. At this moment, the
bully will try and portray their target as mentally ill as a way of abdicating and denying
their responsibility for the injury which they have caused. I call this the mental health
trap.

To handle the mental health trap, on every occasion that the bully implies you are
"mentally ill" or "mentally unstable" or are a person with a
"mental health problem", look the bully in the eye and (preferably with a
witness present) say:

The state of my physical and mental wellbeing today is a direct consequence of your
behaviour towards me over the last xx months/years.

Put this in writing, with support from your union or other representative. You may need
to repeat it. If you are coerced into reporting to occupational health, use this phrase to
identify the cause of your injury. Do not have any qualms about naming the individual
whose behaviour is the cause of your psychiatric injury. Bullies are skilled at finding
and exploiting your forgiving streak in order to get you to retract allegations. This is a
deliberate tactic - so don't be fooled.

If the bully or your employer insist on labelling you as mentally ill, consider
including libel (written), slander (spoken) and defamation of character in your legal
proceedings. If you are being bullied by the medical profession, or the employer's doctor
insists on labelling you as mentally ill, question the competence of a medical
practitioner who is unable to tell the difference between mental illness and psychiatric
injury. If you're fighting this battle, see the page on PTSD for further insight.

Whilst there is no official diagnosis yet, the symptoms of being bullied are congruent
with those of Post Traumatic Stress Disorder (PTSD). I estimate half the UK workforce are
exhibiting many of the symptoms of PTSD, albeit diagnosed as "stress" or
"anxiety" or "fatigue"..

The diagnostic criteria for PTSD are defined in DSM-IV, the fourth edition of the
American Psychiatric Association's Diagnostic and Statistical Manual. This is covered in
detail on a separate page; click here to display.

With bullying, the injury is caused by an accumulation of small events rather than one
major event. The related diagnosis of Prolonged Duress Stress Disorder (PDSD, which is
PTSD over time) may be more appropriate. However, whereas PTSD is in DSM-IV, PDSD is not -
yet. PDSD, or Complex PTSD as it is now becoming known, is a more appropriate diagnosis
for people who experience distressing events every day, such as the emergency services (eg
fire, ambulance and police officers etc), as well as those in abuse situations.

As well as PTSD caused by accident, disaster, violence and rape, David Kinchin's book Post Traumatic Stress
Disorder: the invisible injury includes chapters on PTSD resulting from
terrorism, physical and sexual abuse, and bullying. The official estimate of 850,000 cases
of PTSD in the UK may swell dramatically as a result of this new research (it's estimated
for instance that as many as 14 million people are bullied at work in the UK). This book
contains insight that only someone who has experienced PTSD can impart; as David Kinchin
says in the introduction, "This is the book I so badly wanted to read when I was
traumatised". For an overview, click here; to order a copy
click here.

We know that at least sixteen children in the UK kill themselves each year because of
bullying at school. Each of these deaths is foreseeable, preventable and
unnecessary. The true total could be as high as 80 or more. These estimates,
which are published in the book Bullycide: death at playtime
by Neil Marr and Tim Field, are endorsed by leading childcare charities.

People who are bullied have many common characteristics
including an unwillingness to resort to violence (or legal action) to resolve conflict,
and a tendency to internalise anger rather than express it outwardly. Focusing anger
inward is a recognised cause of depression. Bullying is perpetrated over a long period of
time, perhaps measured in years, and the internalised anger builds to the point where one
of these three occur:

the target starts to exhibit all the symptoms of stress as the internal pressure causes
the body to go out of stasis (this happens in every case)

the target focuses the anger onto themselves and self-harms, either by using drugs
(usually alcohol), or by attempting or committing suicide (the UK has the highest suicide
rate in Europe)

in rare cases, and the target "flips" and starts to exhibit the same
behaviours as the bully; in extremely rare but well-publicised cases, the target returns
to the workplace to carry out a spree killing

How many adult suicides are caused by bullying? Consider the following:

It's likely that many suicides are the result of bullying, but the target's lack of
awareness of what is going on, their unwillingness to confide what is happening, the
traumatization, and the inability to articulate, everyone else's denial, the bully's
accomplished lying and Jekyll and Hyde nature, plus the general lack of knowledge and
awareness of society, prevent the real cause from being identified.

For insight into the stress response and the effects of prolonged stress on the body I
recommend the book Why zebras don't get ulcers: an updated guide to stress,
stress-related diseases, and coping by Robert M Sapolsky (Freeman, 1998, ISBN
0-7167-3210-6). Click here
for suggested reading.

November 2001: more than half of British workers are suffering from stress
and the problem is getting worse, a survey
has suggested.

DEPRESSION AMONG WORKERS IS A PREVALENT AND COSTLY PROBLEM
One in 10 office workers in Britain, the United States, Germany, Finland and Poland
suffers from depression, anxiety, stress or burnout, the results of an International Labor
Organization (ILO) survey show. See: http://www.ilo.org/public/english/bureau/inf/pr/2000/37.htm

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